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Ngamchokwathana C, Chaiear N. Latex anaphylaxis in healthcare worker and the occupational health management perspective: A case report. SAGE Open Med Case Rep 2023; 11:2050313X231179303. [PMID: 37325168 PMCID: PMC10265348 DOI: 10.1177/2050313x231179303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 05/15/2023] [Indexed: 06/17/2023] Open
Abstract
Latex allergy is a critical occupational health problem in healthcare settings. Exposure to latex can lead to severe allergic reactions, including anaphylaxis. However, in epidemiological studies, occupational anaphylaxis due to natural rubber latex is relatively rare. For this reason, allergic reactions from latex exposure in the workplace may not be well aware and, therefore, lead to delayed appropriate management. We reported a female physician who sought occupational health program counseling for her latex allergic reaction following occupational exposure and her two episodes of latex anaphylaxis during medical-surgical procedures. An occupational health management program (e.g. glove replacement and a bracelet with latex allergy labeling) was established. After the intervention, she rarely experienced any allergic symptoms. Given these points, anaphylaxis can be triggered by occupational exposure to latex; thus, occupational health management is key to preventing and managing latex allergies in the workplace.
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Affiliation(s)
| | - Naesinee Chaiear
- Naesinee Chaiear, Department of Community, Family and Occupational Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen 40002, Thailand.
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Editorial: Reconsidering anaphylaxis at the time of COVID-19 pandemic. Curr Opin Allergy Clin Immunol 2020; 20:429-430. [PMID: 32739982 DOI: 10.1097/aci.0000000000000682] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Lee J, Kang YJ. Bermuda grass pollen allergen implicated in clinically relevant cross-reactivity to multiple grains: A case report. J Occup Health 2019; 61:128-134. [PMID: 30698335 PMCID: PMC6499365 DOI: 10.1002/1348-9585.12038] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Revised: 09/28/2018] [Accepted: 10/17/2018] [Indexed: 12/05/2022] Open
Abstract
Background Anaphylaxis is a severe and potentially fatal type of allergic reaction and is characterized by the rapid development of symptoms in the respiratory and circulatory systems, possibly leading to death if not treated properly. Occupational anaphylaxis, which does not exhibit significant differences in pathogenesis from the nonoccupational form, develops in response to work‐related triggers. However, the onset of occupational anaphylaxis can also be triggered by other factors. Therefore, an unexpected episode may occur due to exposure to a previously sensitized antigen or cross‐reaction in the occupational environment, even if the direct trigger has been removed. Accordingly, it is difficult to diagnosis and treat such cases and ensure avoidance of potential triggers. Case presentation An adult male patient developed anaphylaxis following exposure to grass antigens while replacing and burying sewer pipes at a theme park. He later developed cross‐reactivity to other grains. Despite symptomatic treatment, his total serum level of allergen‐specific immunoglobulin E (Ig E) antibodies continuously increased, and thus, he was admitted with severe hypersensitivity, at which time his serum levels of Ig E antibodies specific for Bermuda grass, wheat, and rice had also increased. Conclusion In Korea, Bermuda grass is rarely seen and is generally found in athletic fields or theme parks. Following exposure to this relatively rare grass, our patient exhibited new anaphylactic responses to various external antigens. Therefore, we attribute his severe anaphylaxis to sensitization caused by Bermuda grass exposure and cross‐reactive hypersensitivity to other grains.
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Affiliation(s)
- Jihye Lee
- Occupational Safety and Health Research Institute, Korea Occupational Safety and Health Agency, Ulsan, Republic of Korea
| | - Young Joong Kang
- Department of Occupational and Environmental Medicine, COMWEL Incheon Hospital, Korea Workers' Compensation & Welfare Service, Incheon, Republic of Korea
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Dillane D, Richards SL, Balanay JAG, Langley R. Risk Assessment and Recommendations for Forester Exposure to Hymenoptera. J Agromedicine 2019; 24:146-156. [DOI: 10.1080/1059924x.2019.1567425] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Danielle Dillane
- Environmental Health Sciences Program, Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Stephanie L. Richards
- Environmental Health Sciences Program, Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Jo Anne G. Balanay
- Environmental Health Sciences Program, Department of Health Education and Promotion, East Carolina University, Greenville, NC, USA
| | - Ricky Langley
- Department of Toxicology, North Carolina State University, Raleigh, NC, USA
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Abstract
PURPOSE OF REVIEW The goal of this review is to present an updated summary of the natural history of major childhood and adult food allergies and report recent advances in potential treatments for food allergy. RECENT FINDINGS The most common childhood food allergies are typically outgrown by adolescence or adulthood. However, peanut/tree nut allergies appear to more commonly persist into adulthood. Adults can develop new IgE-mediated food allergies; the most common is oral allergy syndrome. There are multiple different approaches being tried as possible treatments for food allergy. The prevalence of food allergy appears to be increasing but the varied approaches to treatment are being actively pursued such that an approved modality may not be too far in the future.
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Abstract
PURPOSE OF REVIEW The goal of this review is to present an updated summary of the natural history of major childhood and adult food allergies and report recent advances in potential treatments for food allergy. RECENT FINDINGS The most common childhood food allergies are typically outgrown by adolescence or adulthood. However, peanut/tree nut allergies appear to more commonly persist into adulthood. Adults can develop new IgE-mediated food allergies; the most common is oral allergy syndrome. There are multiple different approaches being tried as possible treatments for food allergy. The prevalence of food allergy appears to be increasing but the varied approaches to treatment are being actively pursued such that an approved modality may not be too far in the future.
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Toletone A, Dini G, Massa E, Bragazzi NL, Pignatti P, Voltolini S, Durando P. Chlorhexidine-induced anaphylaxis occurring in the workplace in a health-care worker: case report and review of the literature. LA MEDICINA DEL LAVORO 2018; 109:68-76. [PMID: 29411737 PMCID: PMC7682154 DOI: 10.23749/mdl.v109i1.6618] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 12/18/2017] [Accepted: 12/22/2017] [Indexed: 12/23/2022]
Abstract
BACKGROUND Chlorhexidine has been widely used in the occupational field as an effective antiseptic and disinfectant, especially in the health-care services. Several cases of allergic reactions to chlorhexidine have been reported, both in the general population and in workers. OBJECTIVES To describe a case of occupational chlorhexidine-induced severe anaphylaxis that occurred in the workplace in a health-care worker (HCW) and to update the literature on chlorhexidine as a possible occupational allergen. METHODS We report a case of a severe anaphylactic reaction that occurred in the workplace in a 63-year-old man, who had worked as a dentist for over 20 years. We also carried out a systematic review of the literature according to the PRISMA guidelines. No time or language filters were applied. Only occupational case-reports and case-series were included. RESULTS The causative role of chlorhexidine was suspected owing to the presence of chlorhexidine-containing products in the workplace. Positive results on the Basophil Activation Test confirmed the diagnosis of immediate chlorhexidine-induced hypersensitivity reaction and excluded a role of other disinfectants. No other causes of anaphylaxis were suspected. Our systematic literature review identified 14 cases of occupational chlorhexidine-induced allergy among HCWs; in these cases, the clinical presentation was mild and the symptoms resolved. No cases of systemic reactions in the workplace were reported. CONCLUSIONS This is the first report of chlorhexidine-induced severe anaphylaxis occurring in the workplace. This case report underlines the importance of investigating and being aware of individual and environmental risk factors in the occupational field, which can cause, albeit infrequently, severe reactions with serious consequences.
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Affiliation(s)
- Alessandra Toletone
- Department of Health Sciences (DISSAL), Postgraduate School in Occupational Medicine, University of Genoa, Italy.
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Anaphylaxis in the Workplace. CURRENT TREATMENT OPTIONS IN ALLERGY 2018. [DOI: 10.1007/s40521-018-0155-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Abstract
PURPOSE OF REVIEW Hymenoptera anaphylaxis is one of the leading causes of severe allergic reactions and can be fatal. Venom-specific immunotherapy (VIT) can prevent a life-threatening reaction; however, confirmation of an allergy to a Hymenoptera venom is a prerequisite before starting such a treatment. Component resolved diagnostics (CRD) have helped to better identify the responsible allergen. RECENT FINDINGS Many new insect venom allergens have been identified within the last few years. Commercially available recombinant allergens offer new diagnostic tools for detecting sensitivity to insect venoms. Additional added sensitivity to nearly 95% was introduced by spiking yellow jacket venom (YJV) extract with Ves v 5. The further value of CRD for sensitivity in YJV and honey bee venom (HBV) allergy is more controversially discussed. Recombinant allergens devoid of cross-reactive carbohydrate determinants often help to identify the culprit venom in patients with double sensitivity to YJV and HBV. CRD identified a group of patients with predominant Api m 10 sensitization, which may be less well protected by VIT, as some treatment extracts are lacking this allergen. The diagnostic gap of previously undetected Hymenoptera allergy has been decreased via production of recombinant allergens. Knowledge of analogies in interspecies proteins and cross-reactive carbohydrate determinants is necessary to distinguish relevant from irrelevant sensitizations.
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Abstract
Healthcare workers (HCWs) are exposed to a range of high and low molecular weight agents that are allergic sensitizers or irritants including cleaners and disinfectants, natural rubber latex, and various medications. Studies have shown that exposed HCWs are at risk for work-related rhinitis and asthma (WRA). Work-related rhinitis may precede development of WRA and should be considered as an early marker of WRA. Avoidance of causative exposures through control strategies such as elimination, substitution, engineering controls, and process modification is the preferred primary prevention strategy for preventing development of work-related allergic diseases. There is limited evidence for the effectiveness of respirators in preventing occupational asthma. If sensitizer-induced WRA is diagnosed, it is important to avoid further exposure to the causative agent, preferably by more rigorous application of exposure control strategies to the workplace. This review focuses on allergic occupational respiratory diseases in HCWs.
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Toletone A, Voltolini S, Passalacqua G, Dini G, Bignardi D, Minale P, Massa E, Signori A, Troise C, Durando P. Hymenoptera venom allergy in outdoor workers: Occupational exposure, clinical features and effects of allergen immunotherapy. Hum Vaccin Immunother 2017; 13:477-483. [PMID: 27924689 PMCID: PMC5328232 DOI: 10.1080/21645515.2017.1264748] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/14/2016] [Accepted: 10/25/2016] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To describe (i) the clinical characteristics of workers, exposed to hymenoptera stings, with an ascertained diagnosis of Hymenoptera Venom Allergy (HVA), (ii) the specific role of occupational exposure, (iii) the effect of Venom Immunotherapy (VIT) in reducing the severity of allergic episodes in workers exposed to repeated stings of hymenoptera, and (iv) the management of the occupational consequences caused by allergic reactions due to hymenoptera stings. METHODS Between 2000 and 2013 an observational study, including patients referred to the regional reference hospital of Liguria, Italy, with an ascertained diagnosis of HVA and treated with VIT, was performed. A structured questionnaire was administered to all patients to investigate the occupational features of allergic reactions. These were graded according to standard systems in patients at the first episode, and after re-stings, during VIT. RESULTS One-hundred and 8four out of the 202 patients referred had a complete data set. In 32 (17.4%) patients, the allergic reaction occurred during work activities performed outdoor. Of these, 31.2% previously stung by hymenoptera at work, and receiving VIT, were re-stung during occupational activity. The grades of reaction developed under VIT treatment resulted clinically less severe than of those occurred at the first sting (p-value = 0.031). CONCLUSION Our findings confirmed the clinical relevance of HVA, and described its occupational features in outdoor workers with sensitization, stressing the importance of an early identification and proper management of the professional categories recognized at high risk of hymenoptera stings. The Occupational Physician should be supported by other specialists to recommend appropriate diagnostic procedures and the prescription of VIT, which resulted an effective treatment for the prevention of episodes of severe reactions in workers with a proven HVA.
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Affiliation(s)
- Alessandra Toletone
- Department of Health Sciences, Postgraduate School in Occupational Medicine and Occupational Medicine Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | | | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, Department of Internal Medicine, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Guglielmo Dini
- Department of Health Sciences, Postgraduate School in Occupational Medicine and Occupational Medicine Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | | | - Paola Minale
- Allergy Unit, IRCCS AOU San Martino-IST, Genoa, Italy
| | - Emanuela Massa
- Department of Health Sciences, Postgraduate School in Occupational Medicine and Occupational Medicine Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
| | - Alessio Signori
- Department of Health Sciences, Biostatistics Unit, University of Genoa, Genoa, Italy
| | | | - Paolo Durando
- Department of Health Sciences, Postgraduate School in Occupational Medicine and Occupational Medicine Unit, IRCCS AOU San Martino-IST, University of Genoa, Genoa, Italy
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How should occupational anaphylaxis be investigated and managed? Curr Opin Allergy Clin Immunol 2016; 16:86-92. [PMID: 26828245 DOI: 10.1097/aci.0000000000000241] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
PURPOSE OF REVIEW Anaphylaxis is a systemic allergic reaction that can be life-threatening or fatal and can result from work-related exposures. This review study focuses on the assessment, main triggers, and management of occupational anaphylaxis. RECENT FINDINGS Exposed workers can be sensitized through inhalation and skin contact, and the risks increase with penetration of the allergen through the skin. The main eliciting agents of occupational anaphylaxis include stinging insects and animal bites, natural rubber latex and other vegetable allergens, food products, and drugs. Workers sensitized to occupational allergens may also develop anaphylaxis outside the work environment from exposure to the same or to cross-reacting allergens. Cofactors at work such as exercise may increase the risk. The relevant medical records and laboratory tests (e.g. tryptase) performed during the episode should be reviewed. SUMMARY It is very important to confirm the diagnosis and to identify the specific trigger of anaphylaxis. Component-resolved diagnosis may help in the identification of primary sensitizers or cross-reactive allergens. Adrenaline must be administered to all patients experiencing anaphylaxis. Removal from exposure is mandatory to prevent further episodes. A written emergency management plan, health and safety education, and training and surveillance should be enforced in occupations at greater risk.
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Reza Masjedi M, Saeedfar K, Masjedi J. Occupational Allergies: A Brief Review. EUROPEAN MEDICAL JOURNAL 2016. [DOI: 10.33590/emj/10313903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2023] Open
Abstract
Occupational allergies are groups of work-related disorders that are accompanied by immunologic reaction to workplace allergens and include occupational asthma, rhinitis, hypersensitivity pneumonitis, dermatitis, and anaphylaxis. This mini review presents a brief analysis of the more important aspects of occupational allergic disorders.
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Affiliation(s)
- Mohammad Reza Masjedi
- Pulmonary Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Tobacco Control Research Center, Iranian Anti-Tobacco Association, Tehran, Iran
| | - Kayvan Saeedfar
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Javid Masjedi
- Tobacco Control Research Center, Iranian Anti-Tobacco Association, Tehran, Iran
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